Healthcare Provider Details

I. General information

NPI: 1467548008
Provider Name (Legal Business Name): ALBERTO ANTONIO BOLANOS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 08/22/2025
Certification Date: 08/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 HOSPITAL LOOP NE STE 201
ALBUQUERQUE NM
87109-2128
US

IV. Provider business mailing address

100 S SAN MATEO DR SUITE 424
SAN MATEO CA
94401-3805
US

V. Phone/Fax

Practice location:
  • Phone: 505-727-4430
  • Fax:
Mailing address:
  • Phone: 650-262-4262
  • Fax: 650-262-5862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberG84190
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD2024-0451
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: